Extensive Salmonella enteritidis endocarditis involving mitral, tricuspid valves, aortic root and right ventricular wall.

After conducting a PubMed search, 11 articles describing a total of 12 cases of native valve Salmonella enteritidis (S. enteritidis) endocarditis were identified in the English literature. Only 13 cases of prosthetic valve endocarditis attributed to S. enteritidis have been published in the English literature. Only 1 case involving the myocardium and other valves concomitantly could be located. Transthoracic echocardiography proved inadequate to demonstrate valvular vegetations. Transesophageal echocardiography was instrumental in establishing the diagnosis of endocarditis by documenting vegetations. S. enteritidis endocarditis can cause devastating endovascular infections in immunocompromised patients. Patients who present with multiple vague symptoms with medical histories that include diabetes mellitus, immunocompromise, and prosthetic heart valves should alert clinicians to strongly consider S. enteritidis endocarditis in their differential diagnoses. Despite considerable effort, S. enteritidis endocarditis poses very high risk for morbidity and mortality.

Delay in diagnosis: trauma- and coinfection-related cutaneous leishmaniasis because of Leishmania guyanensis infection.

Trauma can trigger the onset of some lesions of cutaneous leishmaniasis (CL). In this study, we present the case of a 65-year-old man who developed persistent, ulcerative, nodular lymphangiitis at the site of elbow abrasions from a fall during a trip to northeastern Brazil. Skin and lymph node biopsy showed tuberculoid granulomatous inflammation and Grocott-methamine silver-positive yeast forms consistent with Sporothrix and Staphylococcus lugdunensis was identified from tissue culture. Antibacterial and antifungal treatment produced short-term healing. Crusted papules recurred at the sites of injury 3 months later and persisted despite therapy. After 15 months, two punch biopsies showed scarring and granulomatous inflammation; cultures and histochemical stains were negative for microorganisms. Because of refractory disease, multiple polymerase chain reaction (PCR) assays for infectious agents on DNA extracted from the biopsy specimens were performed, and Leishmania guyanensis was detected in all specimens. The patient refused pentavalent antimonial therapy and elected for excision of the CL lesions. After 2 years of follow up, he is without disease. CL should be considered in the differential diagnosis in patients who present with ulcerative, nodular lymphangiitis; have a history of travel to endemic regions; and describe a traumatic insult to the affected region. PCR methods for infectious agents increase the sensitivity and specificity of detecting causative agents in these patients who are negative by routine methods. In some, leishmaniasis may be an occult infection whose presence is heralded by trauma. Coinfection, by altering the immune response, may have facilitated the clinical acquisition of CL.